Massachusetts Health Care Quality and Cost Council 1

1
Performance Measurement Expert Panel

• Presentation to the HCQCC
• October 21, 2009
• Dwight McNeill, Assistant Commissioner, DHCFP and
  Katherine Shea, Administrative Director, HCQCC

2
Proposed Purposes of Performance Measurement

• Inform providers about opportunities for
  improvement to achieve better outcomes.
• Inform policy makers to help them set goals and
  targets and to monitor and fine tune
  interventions to improve statewide health and
  health care.
• Inform consumers to help them make the best
  decisions possible about their health care
  choices.
• Provide the foundation for incentive systems to
  reward the delivery of high quality and efficient
  health care.
• Influence delivery systems to become more
  integrated, coordinated, and patient centered.
• Hold all stakeholders accountable for their
  performance in improving the health status of the
  residents of Massachusetts.

3
Proposed Goals of Expert Panel

• Achieve consensus on a set of performance
  measures to promote better health and health care
  for the residents of the Commonwealth in the five
  PM areas and propose these to the Quality
  Safety Committee
• Provider quality improvement
• Statewide goals and monitoring of performance
• Consumer decision making
• Incentives alignment
• Patient centered system change

4
Proposed Near Term Priorities

• Make recommendations on a state wide dashboard of
  measures to monitor state goals, including
  benchmark targets.
• Make recommendations on uniform measures of
  provider performance that may be used for
  incentives, tracking health improvements, and
  tracking quality of care.

5
Proposed Key Features of the Expert Panel

• Panel composition
• Representation from a range of stakeholders,
  expert in performance measurement, to advise on
  the selection of important and valid measures
• Payers, purchasers, providers, academia,
  consumers, quality of care advocates
• HCQCC representation by a Council member
• Panel Support
• Dwight McNeill, Assistant Commissioner, DHCFP
• Meeting facilitator, strategic lead, agenda,
  measurement expertise
• Katherine Shea, Administrative Director, HCQCC
• Analysis, liaison to Council, administration
• Process
• Expert Panel will give final consensus
  recommendations to the Quality and Safety
  Committee and the Chair of the Expert Panel will
  present the recommendations to the full Council.
• Liaison with
• All state quality-related healthcare initiatives
  (see list on next slide)
• Workgroups will be formed as deemed necessary by
  the Panel

6
Quality Related Healthcare Initiatives in the
Commonwealth

• Public
• HIT Council
• Disparities Council
• MassHealth P4P Program
• MassHealth Medical Homes Project
• Statewide Multipayer Medical Homes Project
• MassHealth Dual Eligibles Program
• GIC
• Healthy Massachusetts Initiative
• HITEP input on definition of meaningful use
  measures for HIT
• State Quality Improvement Institute
• Private
• MAHP
• Aligning Forces for Quality
• MHQP

7
Background on Statewide Dashboard

• Review HCQCC goals and priorities and measures
• Develop composite and component measures derived
  from existing HCQCC measures
• Consider other system and state wide measures for
  future inclusion, e.g. all hospital mortality,
  potentially preventable readmissions, healthy
  behaviors index, and community health index.
• Learn from other state reports on quality
  including those by AHRQ and the Commonwealth Fund
  
• Propose state wide dashboard to Quality Safety
  Committee

8
Background on Payment Alignment

• I. Support administrative simplification by
• Achieving consensus among payers on measures and
  specifications for pay for performance programs.
• Harmonizing efforts across the Commonwealth to
  reduce burden on providers derived from multiple
  and conflicting expectations.
• Review and endorse MAHPs work on consensus among
  private health plans.
• Need to integrate public perspectives including
  MassHealth, and GIC, and Connector.
• MAHP can maintain and update health plan P4P
  measures

9
MAHP Topics (Alignment Conditions)

• Antidepressant Medications
• Asthma
• ADHD Treatment
• Breast Cancer Screening
• Cardiovascular Disease
• Cervical Cancer Screening
• Childhood Obesity
• Chlamydia Screening

• Diabetes
• Colorectal Cancer Screening
• Hypertension
• Otitis Media/Pharyngitis/Bronchitis
• Patient Experience
• Cost-Effect Prescribing
• Well-Child Care
• Information Technology

10
Examples of MAHP Mapping
11
HCQCC Leadership on Performance Alignment

• II. Develop a strategic framework for incentives
  for clinicians that promote more care
  coordination, integration, patient centered care,
  coordination with new payment models, and
  reductions in disparities by race, ethnicity, and
  economic status.
• May require different sets of measures at the
  individual clinician, group, and system levels
• May require a broader combination of stakeholders
• HCQCC, through its QS PMA expert panel, can
  provide leadership and convening
• Good starting place may be measures for
  patient-centered medical homes

12
Summary HCQCC Quality MeasuresFor Statewide
Dashboard

• Ensure patient safety and effectiveness of care
• Eliminate Hospital Associated Infections by 2012
• Certain types of infections included at present,
  including some CVC-BSI and some SSIs.
• Measures on the full spectrum of infection types
  in health care settings
• Hospitals progress implementing recommendations
• Eliminate serious reportable events and never
  events
• Leapfrog composite and component safe practices
  scores.
• Type and number of SREs by hospital and actions
  taken.
• Improve overall patient safety and effectiveness
  of care
• Measure of whole system quality and safety, e.g.
  mortality.
• Improve screening and management of chronic
  illnesses in community
• Improve care of congestive heart failure,
  diabetes, and asthma
• Reduce disease complication rates, readmission
  rates, and avoidable hospitalizations
• Prevent hospitalizations for ambulatory sensitive
  conditions
• Implement the medical home model in all primary
  care practices
• Measurements of health care which current data
  are inadequate
• End of life care.
• Eliminate racial and ethnic disparities in health
  and access and utilization
• Across all measurement areas

13
Proposed Members for Expert Panel on Performance
Measurement Alignment
14
Timetable/ Next Steps

• Begin reaching out to key members of Expert Panel
  for interest and availability for first meeting
• Develop background material on Panel purpose,
  goals, priority areas, work plan, and agenda for
  first meeting.
• Schedule kick-off meeting for late October